BG LandRovers Dixies Challenge Rally 2017 Internet Entry Form

Entries to this event are now closed and this page is for record only

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SUNDAY 30TH APRIL 2017

ORGANISED BY FORRESTERS CAR CLUB & FOREST OF DEAN MOTOR CLUB

Entries Secretary: Richard Lomax

14 Charnwood Drive
Pontprennau
Cardiff
CF23 8NN

Mobile: 07740 457084

E-Mail: dixiesentries@gmail.com

Held under the General Regulations of the Motor Sports Association (incorporating the International Sporting Code of the FIA) and the Supplementary Regulations.

Welcome to the BG Landrovers Dixies Challenge Rally 2017 On-line Entry system. Please follow the steps below to enter the rally.

  1. Complete all the fields in the form below. The fields with red backgrounds are mandatory.
  2. Once you have hit the "Enter the Rally" button at the end you will receive an automated response confirming we have received your entry form.
  3. There are then two ways to pay
    1. The easiest and cheapest way to pay is on-line by bank transfer. If you have internet or telephone banking, you can arrange for the fees to be paid directly into our account. This is our recommended payment method as entries are expected to at a premium and will be accepted in order of receipt of funds.
      Bank Lloyds Bank plc
      Sort Code 30-66-77
      Account No. 52163660
      Account Name Forest of Dean M C Ltd
      Reference Driver's and CoDriver's Surnames
    2. You can send a cheque, made payable to 'Forest of Dean Motor Club' to the Entries Secretary at the address above. Please note entries are accepted in order of receipt of funds and hence there will be a delay in us receiving your cheque, which will put you down the entry list.
    3. Within 72 hours of us receiving the payment for your entry you should receive an e-mail confirming your entry from the Entries Secretary. NOTE: WITHOUT PAYMENT YOUR ENTRY WILL NOT BE VALID.

If you do not receive a response within 3 days of the expected bank transfer payment date (or longer if you have paid by cheque), or if you have any other questions, please e-mail dixiesentries@gmail.com

All the fields with a red background must be filled in, or you will not be able to continue with your entry. Please put TBA in any red field which you do not know the details for.

Please provide any missing information or advise any changes by e-mail as soon as you are aware of them and as far as possible prior to arriving at the event.

Document Addressing
E-Mail address for communication
Real Name of this person
Whom should we send Finals and Results to?
Driver
Full Name
Address
Post Code
Mobile Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
Driver's Parent or Guardian (under 18 only)
Name
Telephone Number (preferably mobile)
Relationship
Co-Driver
Full Name
Address
Post Code
Mobile Number
Competition Licence Number
E-Mail Address
Club
Date of Birth
Co-Driver's Parent or Guardian (under 18 only)
Name
Telephone Number (preferably mobile)
Relationship
Car
Make
Model
Colour
Registration Number
Engine Capacity
Class
Insurers details if NOT using JELF Scheme 
Insurer & Policy No.
Address.
Championships
WAMC Welsh Historic Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
WAMC King of Epynt
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
WAMC Mixed Surface Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
HRCR Stage Masters Historic Stage Rally Challenge
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
HRCR Old Stager Historic Rally Championship
Crew Members Registered
Driver Championship Registration Number
Co-Driver Championship Registration Number
Person to be contacted in case of serious accident to Driver
Name
Telephone Number (preferably mobile)
Relationship
Will this person be attending the event?
Person to be contacted in case of serious accident to Co-Driver
Name
Telephone Number (preferably mobile)
Relationship
Will this person be attending the event?
Seeding information - most recent results for the driver
Event Name and ClubYearTypeSurfaceOverall PositionClass Position
Seeding - Competitor Opinion
Out of 80 entries, where do you think you should be seeded?
Scrutineering
When would you prefer to scrutineer? Saturday 15.00hrs - 19.00hrs
Sunday 07.30hrs - 09.30hrs
Fees - see above for how to pay
Entry Fee £
Club Membership £
Insurance £
Total Money to be sent£
How will you pay? (Bank Transfer / Cheque)

The details on this form will be held on computer in order to be used for the administration of this event. They will also be used to send you information about future events organised by this club, unless you untick this box to indicate you do not wish to receive information on further events.
The details on this form may also be passed on to other motorsport organisations, unless you untick this box to indicate you do not wish these details passed on.

Remember your entry is subject to receipt of the correct entry fee. An automated acknowledgement is NOT confirmation of entry. Rejected entries and entries held in reserve will be informed by e-mail to the address(es) given above.

If you wish to pay by bank tranfer (online banking) payments can be made to Forest of Dean M C Ltd,  Sort Code 30-66-77 account no 52163660. Please enter Driver's and CoDriver's Surnames in the 'Reference' field.

Please provide any missing information or advise any changes by e-mail as soon as you are aware of them and as far as possible prior to arriving at the event.

By clicking on the "Enter the Rally" button below you agree to the following: "I declare that I have been given the opportunity to read the General Regulations of the Motor Sports Association and, if any, the Supplementary Regulations for this event and agree to be bound by them. I declare that I am physically and mentally fit to take part in the event and I am competent to do so. I acknowledge that I understand the nature and type of the competition and the potential risk inherent with motor sport and agree to accept that risk. Further, I understand that all persons having any connection with the promotion and/or organisation and/or conduct of the event are insured against loss or injury caused through their negligence.

The use of the vehicle hereby entered will be covered by insurance as required by the law which is valid for such part of this event as shall take place on roads defined by the law.  If I have selected and paid for the standard premium JELF cover, I meet the criteria as per section 19 of the supplementary regulations."

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